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Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.
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Objective:To investigate the clinical features and prognostic factors in children with sepsis complicated with myocardial injury.Methods:The clinical data of children with sepsis complicated with myocardial injury from January 2017 to January 2019 in Department of Intensive Care Unit, Children′s Hospital of Kunming City, were retrospectively analyzed. The pediatric critical illness score (PCIS) at admission, gender, age, infection site, clinical outcome, mechanical ventilation and blood purification were recorded. The etiological results, creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), myoglobin, hypersensitive cardiac troponin T (hs-cTnT), procalcitonin (PCT), lactate, left ventricular ejection fraction (LVEF), cardiac output, left ventricular truncation rate (LVFS) were recorded. According to the clinical results, the children were divided into improvement group and deterioration group, and the clinical data of each group were compared. The receiver operating characteristic (ROC) curve and multivariate Logistic regression were used to screen the relevant clinical indicators that could predict the prognosis of children.Results:A total of 138 children with sepsis complicated with myocardial injury were enrolled. Thirty cases died in 28 d, and the mortality of 28 d was 21.7%. The respiratory tract was the main infection site, and the main pathogens were gram-negative bacteria and virus. The 35.4% (28/79) of children were complicated with multiple infections. There were 102 cases in improvement group; and there were 36 cases in deterioration group, among whom 5 cases died in hospital and 31 cases was discharged without treatment. The proportion of the girls in deterioration group was significantly higher than that in improvement group: 63.9% (23/36) vs. 34.3% (35/102), and there was statistical difference ( P<0.01); there were no statistical differences in age, infection site, mechanical ventilation, blood purification and PCIS between 2 groups ( P>0.05). The hs-cTnT and lactate in deterioration group were significantly higher than those in improvement group: (1.87 ± 0.67) ng/L vs. (1.62 ± 0.51) ng/L and (0.46 ± 0.31) ng/L vs. (0.34 ± 0.27) ng/L, and there were statistical differences ( P<0.05); there were no statistical differences in CK, CK-MB, myoglobin, PCT, LVEF, cardiac output and LVFS between 2 groups ( P>0.05). ROC curve analysis result showed that the hs-cTnT and lactate were risk factors for predicting clinical prognosis in children with sepsis complicated with myocardial injury, the area under the curve were 0.623 and 0.613, the optimal value were 159.59 and 2.65 ng/L, with a sensitivity of 36.1% and 55.6%, and a specificity of 98.2% and 70.6%. Multivariate Logistic regression analysis result showed that the hs-cTnT and gender were independent risk factors for prognosis ( OR = 2.237 and 0.286, 95% CI 1.093 to 4.578 and 0.127 to 0.644, P = 0.028 and 0.003). Conclusions:The 28 d mortality in children with sepsis complicated with myocardial injury is higher, and the respiratory tract is the most common infection site. The increased hs-cTnT and lactate levels indicate that the prognosis is poor in children with sepsis complicated with myocardial injury. The hs-cTnT and and gender are independent risk factors of prognosis.
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Objective:To summarize the classification of etiology, age of onset, prognosis of children with convulsion, so as to provide experience guidance for clinicians engaged in pediatric emergency department.Methods:The clinical data of children with convulsions received in the emergency department of Children′s Hospital Affiliated to Kunming Medical University from January 2015 to December 2018 were analyzed retrospectively.Results:During the four-year period, 2 957 children with convulsion were received in the emergency department, accounting for 22.20% of the total number of critically ill children in the observation room of the emergency department, and the ratio of male to female was 1.7∶1.The etiological diagnosis of convulsion in emergency are as follows: febrile convulsion(733 cases, 24.79%), central nervous system infection(477 cases, 16.13%), unexplained convulsion(476 cases, 16.09%), epilepsy(371 cases, 12.55%), benign infantile convulsions with mild gastroenteritis(240 cases, 8.12%). The age of onset: 8.25% were in neonatal period, 33.99% were in infant, 34.87% were in toddler′s age, 12.17% were in preschool age, 7.88% were in school age and 2.84% were in adolescence.Destination statistics: 72.00% were admitted to hospital for further treatment, 13.29% were transferred to neurology clinic, 7.85% to pediatric clinic, 1.66% to rehabilitation clinic, and 0.17% died.Inpatient department: 43.64% were admitted to department of neurology, 17.52% to pediatric intensive care unit, 13.71% to department of neonatology, 12.64% to department of gastroenterology and 2.72% to department of rehabilitation.Conclusion:Febrile convulsion is the main cause of convulsion in children who were received emergency treatment in our hospital.Most of the convulsion cases are from birth to preschool age, and the prognosis is good after active treatment.
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Hemophagocytic lymphohistiocytosis(HLH)is a disease caused by various pathogenic factors and characterised by activated lymphoid cells and tissue cells,which release massive cytokines and results in hypercytoki-nemia and severe functional distraction of visceral organs.The disease is classified to primary/inherited HPS and sec-ondary/reactive HPS.The hypercytokinemia play a key role in the process of disease development.In this article,the hypercytokinemia in the pathogenesis of children HLH was reviewed.
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Objective To explore the efficacy of low tidal volume ventilation strategy in children with acute hypoxia respiratory failure (AHRF).Methods A total of 79 hospitalized children with AHRF from Aug 2006 to Jul 2011 in PICU of Kunming Children's Hospital were enrolled in this study.The observation group in-cluded 55 children who received low tidal volume ventilation strategy (6-8 ml /kg),while the other 24 children (control group)were given traditional mechanical ventilation (10-12 ml /kg).Oxygenation situations such as PaO2 ,PaCO2 ,PaO2 /FiO2 ,oxygen index and blood gas pH value,organ function,mechanical ventilation complica-tions,hospitalization days and expenses in PICU and the mortality were observed.Results (1)PaO2 ,PaO2 /FiO2 and oxygen index in the observation group were better than those in control group after 24 h mechanical ventilation [(68.51 ±7.53)mmHg(1 mmHg =0.133 kPa)vs.(61.64 ±9.28)mmHg,(162.9 ±21.84)mmHg vs.(152.1 ± 19.03)mmHg,and 18.85 ±4.1 vs.26.53 ±5.2,respectively],and there were significant differences between two groups (P ﹤0.05);and there were also significant differences between two groups in the results after 48 h and 72 h mechanical ventilation.(2)The PaCO2 was (47.48 ±10.52)mmHg after 24 h in observation group,while the PaCO2 in control group was (30.17 ±6.59)mmHg,and it suggested excessive ventilation.(3)Mechanical venti-lation time (7.6 ±3.1)d and hospitalization days (12.8 ±3.6)d were shorter in observation group(P ﹤0.01). Barotrauma (7.3%)and mortality (20.0%)in observation group was significantly lower than those in control group (29.2%,41.6%;P ﹤0.01).The number of damaged organs in observation group was lower than that in control group (P ﹤0.05).Conclusion Low tidal volume ventilation with appropriate positive end expiratory pressure could improve oxygenation,prevent alveolar collapse,reduce complications and mortality for children with AHRF,it should be applied for the treatment of children with AHRF.
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Objective To determine the pathogenic bacteria distribution and drug resistance in children with sepsis. Methods From 2002 to 2011, a ten consecutive years of monitoring of pathogenic bacteria distribution, drug resistance in pediatric patients with sepsis were conducted. Results From 2002 to 2011, 2 493 strains of pathogenic bacteria were detected in 68 419 specimens of blood culture. The positive rate was 3.64%. Among them, 1 913 strains (76.73%) were the gram-positive bacteria (G+bacteria), 562 strains (22.54%) were gram-negative bacteria (G-bacteria) and 18 strains (0.72%) were fungi. From 2002 to 2006, 959 strains (4.73%) of pathogenic bacteria were detected in 20 287 specimens of blood culture. Among them, the G+bacteria was 731 strains (76.23%), G-bacteria was 228 strains (23.77%). From 2007 to 2011, 1 534 strains (4.73%) of pathogenic bacteria were detected in 48 132 specimens of blood culture, G+ bacteria was 1 182 strains (77.05%), G-bacteria was 334 strains (21.77%), fungi was 18 strains (1.17%). The positive rate of blood culture, the pathogenic bacteria distributions of G+, G-, and fungi were signiifcantly different between the ifrst and the second 5 years (P<0.01). The positive rate of G+bacteria tended to increase and the positive rate of G-bacteria tended to decrease. Com-paring between the ifrst and second 5 years, the positive rate of coagulase-negative staphylococci, Klebsiella, Alcaligenes, fungi tended to increas, and the positive rate of Staphylococcus aureus, Enterococcus, Pseudomonas, Salmonella tended to decrease. The distribution of pathogens in different age groups of children with sepsis also were signiifcantly difference (P<0.001). Over the 10 years, G+positive bacteria were highly resistant to penicillin and erythromycin, but not resistant to Vancomycin. ESBLs positive E. coli strains and Klebsiella Trevisan became highly resistant to antibiotics. Salmonella was sensitive to commonly used antibiotics. Conclusions Coagulase negative staphylococcus was the most common pathogenic bacteria in children with sepsis in the last 10 years, multiple pathogenic bacteria also show a growing trend in drug resis-tance.
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Objective To explore the effect of low tidal volume ventilation on the treatment of children with acute respiratory distress syndrome (ARDS).Methods Forty-four hospitalized children with ARDS from Jan 2008 to Dec 2011 at Kunming Children's Hospital were enrolled in this study.The observation group included 24 patients who received the treatment of low tidal volume ventilation (6 ～ 8 ml/kg),while the other 20 patients were in the control group who were given traditional volume ventilation (10 ～ 12 ml/kg).Oxygenation situations and blood gas analysis at 24,48,72 h after ventilation、mechanical ventilation complications,and the mortality in the first 28 days were observed.Results The ratios of PaO2/FiO2 were 104 ±23.6 in observation group and 112 ±34.7 in control group (P ＞0.05).However,after 24,48 and 72 h of ventilation,the ratios of PaO2/FiO2 showed statistical significance (t ≥2.01,P ＜0.05 ; t ≥2.74,P ＜ 0.01).Barotrauma in observation group was significantly lower than that in control group (x2 =6.97,P ＜ 0.01).The mortality (16.7％) of the observation group was significantly lower than that (50％) of the control group (x2 =5.58,P ＜ 0.05).Conclusions Low tidal volume ventilation can reduce complications and improve oxygenation of ARDS patients,and reduce the mortality in ARDS children.The improved rescue technology should be applied for the treatment of children with ARDS.